Provider Demographics
NPI:1831597384
Name:ANDERSEN, PATRICIA (MS LMFT CMHS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MS LMFT CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 3RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-6007
Mailing Address - Country:US
Mailing Address - Phone:360-560-7735
Mailing Address - Fax:360-577-8879
Practice Address - Street 1:1157 3RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-6007
Practice Address - Country:US
Practice Address - Phone:360-560-7735
Practice Address - Fax:360-577-8879
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60848008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2048981Medicaid
WACG 60139301OtherCOUNSELOR AGENCY AFFILIATED REGISTRATION